Request for Accommodation:

Student Information

Last Name:

First Name:

Middle Name:

(please provide if available)

Please describe the reasonable accommodations that are necessary:(select all that apply)
Access to internet
Elevator access
Moveable seating
Wheelchair access
ACCESS will be placing an accessible table/desk into the classroom
Additional seats for care attendants/aides, CART/typewell transcribers, interpreters, etc.Please indicate the number of additional seats needed:
Other - See Comments Below